Anterior mid-tibial stress fractures are a clinical problem. The diagnosis can be delayed because the normal radiographic anteroposterior and side views may only show thickening of the anterior cortex. Oblique views and tomography are often required. Isotope scan confirms the diagnosis and is the method of choice. The treatment varies from rest to operational intervention. A delayed union of this area of the tibia is a potential complication and is a high risk for an athlete, a complete fracture being the most serious complication. We present the results of conservative and operative treatment of 17 patients. Of these cases, nine progressed to a delayed union and operation was performed using transversal drilling with a 2.0-2.5 drill. We recommend a period of rest up till six months and surgical intervention with drilling of the hypertrophied cortex if there is any suspicion of a possibility of a delayed union. Also, if there is a long delay in the diagnosis, operative treatment is recommended. Biopsy is recommended during surgery for differential diagnosis.